Introduction to Medicare Part C in North Carolina (Medicare Advantage)

Have you heard about Medicare coverage gaps? These are the potentially expensive gaps in the hospital and outpatient services which Medicare Parts A and B are designed to provide for. Although Medicare aims to be comprehensive, these gaps in your coverage benefits need to be covered with some type of supplemental insurance – or you could end up paying thousands out of pocket. There are many different forms of Medicare supplemental insurance which are designed to address the concern of Medicare coverage gaps. Medicare Part C, a.k.a. Medicare Advantage, is one such supplement. It will be the main focus of this article.

Federal Regulations for Medicare Advantage

Medicare Advantage is separate from your federal Medicare benefits in that, once you sign up for an Advantage plan, the government is no longer responsible for your health care. Your benefits are replaced by a health insurance plan provided by a private company. However, in order to protect you from inferior coverage, Medicare Advantage plans are regulated by the federal government. It is illegal for any company to sell you an advantage plan unless the promised benefits are equal to or greater than what Medicare offers. Indeed, most providers will offer you many more coverage and benefits options than Medicare alone. But those additional benefits may come with a higher price tag.

Medicare Advantage Enrollment In North Carolina

More than a quarter of North Carolina seniors (28% of them to be exact) have decided to switch to a Medicare Advantage policy. Those aren’t the highest rates nationwide, but the number isn’t nothing to sneeze at either. Below, you can get a snapshot of which types of Advantage plans are more popular than others:

Plan Type Enrollment Percentage
HMO Plans 59%
Local PPO Plans 13%
Special Needs Plans 11%
Regional PPO Plans 9%
Private Fee-For-Service Plans 5%
Other (Cost Plans, MSA’s, etc.) 3%

Plan Coverage & Cost

The state you live in, your age, and your current health status may all play a role in determining how much you’ll pay for an Advantage plan. Even very specific information, such as your zip code, could make a significant difference in your quoted rate. Below this paragraph, you can take a look at a chart with a list of estimated rates which seniors near you are being quoted right now:

Most Popular Medicare Advantage Plans in North Carolina

Your personal circumstances, such as your budget and your overall health care needs, will determine which plan you choose. Each plan is different, and will vary according to what type of provider network your plan includes. Selective provider networks are usually the least expensive, but include fewer doctors and facilities for you to visit. Less selective networks are the exact opposite – you’ll have plenty of choices when it comes to medical care, but at a higher cost.

Helpful Medicare Advantage Tips & Tricks

Doctor/Provider Network Restrictions

As mentioned earlier, your provider network is a significant factor in your Medicare Advantage plan. Unlike some other Medicare supplement plans, Advantage plans are not as universally accepted as Medicare itself. Medicare Advantage plans are limited to a select network of doctors and facilities which have agreed to provide medical care to seniors who subscribe to specific Advantage plans. Check with your current doctor to see what, if any, Medicare Advantage provider networks they are a member of before you start shopping for a policy.

Doctor/Providers List

Drug, Vision and Dental Coverage

Medicare Advantage provides you with enough coverage to equal that of Medicare, and also protect you from some of the potentially expensive Medicare gaps. Additionally, you will have the option of adding extra (sometimes called “ancillary”) coverage which most other supplement insurance will not offer. These options include dental, vision, and prescription drugs (MAPD plans incorporate Medicare Part D into their benefits package). Of course, you’ll have to pay higher rates for more benefits. But for some seniors, having all of their medical needs covered under one policy is worth the premium.

Enrollment Options & Best Time To Enroll

As soon as you turn 65, you should begin the enrollment process for Medicare (and also for Medicare Advantage). The sooner you enroll, the easier it is to get approved for coverage by the plan of your choice. If you try to enroll outside of your IEP (see below) and do not qualify for a Special Enrollment Period, it becomes significantly harder to qualify for coverage. And even if you enroll on time, serious medical conditions (such as End Stage Renal Disease) can significantly complicate your search for affordable coverage. For more information, you can take a look at our Medicare Advantage Enrollment Options page, consult your state department of insurance, or talk to a local insurance agent near you.

  • Initial Enrollment Period: 6-month timeframe when you first enroll in Medicare to purchase a Medicare Advantage plan.
  • Annual Enrollment Period (AEP): This timeframe runs from October 15th through December 7th every year, and during this time you can change or cancel your Medicare Advantage and part D drug plan.
  • Special Enrollment Period (SEP): During special circumstances, you may be eligible to purchase/change a plan outside of the Annual Enrollment Period. Things such as moving out of the plans’ service area, losing group health or employer coverage, a company no longer offering plans in the area, etc. are all events that could trigger a SEP.

What Medicare Advantage Plan Is Best For Me?

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